Clinical Pathways of Cardiomyopathy

The cardiomyopathies are diverse diseases of the myocardium which have differing modes of onset, various clinical features, and multiple outcomes. The illness may commence as a purely electrocardiographic syndrome in patients suffering systemic infections; it may start as acute myopericarditis, as asymptomatic cardiomegaly, as isolated arrhythmia, as sudden, severe pulmonary edema, or as insidiously developing congestive heart failure.The ultimate fate of patients with benign forms of acute myocarditis is not certain. Most patients whose myocarditis is manifest only by electrocardiographic abnormalities appear to recover fully; some patients who have persisting ECG changes and/or cardiomegaly may develop late disability upon further follow-up.Cardiomegaly due to cardiomyopathy may exist for many years without symptoms or may be associated with intractably progressive congestive heart failure. Some patients suffer periodic episodes of myocardial failure, but can survive ten or more years in reasonable comfort with adequate rest and close medical supervision. This type of relapsing course is increasingly common as the management of congestive heart failure improves. Emboli, arrhythmias, and sudden death frequently complicate the course of cardiomyopathy.